Multispecialty Denial Coder

Role & responsibilities

1. Denial Management & Analysis

• Review and analyze denied claims across multiple specialties.
• Identify root causes for denials (e.g., coding errors, documentation deficiencies, payer policies).
• Categorize denials based on common patterns (e.g., medical necessity, bundling issues, coding specificity).

2. Coding & Compliance

• Perform accurate medical coding for denied claims using

  ICD-10-CM, CPT, and HCPCS

  codes.
• Ensure coding compliance with

  CMS, payer guidelines, and HIPAA regulations

  .
• Work with physicians and medical teams to clarify documentation and correct coding issues.
• Stay updated on payer-specific coding rules and regulatory changes.

3. Claims Correction & Resubmission

• Correct coding errors and resubmit claims within payer timelines.
• Prepare appeals with supporting documentation, coding guidelines, and medical records.
• Communicate effectively with insurance companies to resolve claim disputes.

4. Documentation Improvement & Provider Education

• Provide feedback to physicians and clinical staff on documentation best practices.
• Conduct training sessions to reduce recurring coding errors and denials.
• Recommend process improvements to prevent future claim rejections.

5. Reporting & Performance Tracking

• Maintain records of denied claims, resolutions, and financial impact.
• Generate reports on denial trends, coding accuracy, and revenue recovery.
• Collaborate with revenue cycle teams to improve overall claim acceptance rates.

6. Cross-functional Collaboration

• Work closely with

  billing teams, insurance follow-up specialists, and revenue cycle managers

  .
• Coordinate with

  compliance officers and auditors

  to ensure regulatory adherence.
• Communicate effectively with

  providers, payers, and leadership teams

  .